Help at Any Cost Unknown Binding
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These programs have enrolled tens of thousands, much of the business is unregulated, and most complaints are dismissed without investigation as simply the lies of troublemakers. The cost of tough love treatment is comparable to the tuition at an Ivy League university. Since insurance generally doesn't cover this care, upper and middle classes are the primary targets. Beatings, extended isolation and restraint, public humiliation, food deprivation, sleep deprivation, forced exercise to the point of exhaustion, sensory deprivation are common. Incessant verbal attacks are a core component. In essence, these abusive, dehumanizing practices are those that reformers of mental hospitals and prisons have attempted to stamp out. While they cannot prove their methods are effective in the long run, they let testimonials tell the story - medical history has shown this to be a poor way to sort out helpful treatments from fraudulent ones.
'Help at Any Cost' goes on to examine four major examples in detail - Straight Incorporated, the North Star wilderness boot camp, the World Wide Association of Specialty Programs, and the KIDS program.
Author Szalavitz contends that not only is the notion that tough love is effective incorrect, the even the need for treatment for most of the teens who currently receive it is suspect. Government statistics show that levels of youth violence, suicide, drug use, pregnancy, and overall mortality have all decreased drastically in recent years. Yet, the media constantly reiterate the idea that each generation's challenges are worse than the last's - continuous fear-mongering.
engrossed from beginning to end. The personal stories shared from teens and their family members are truly harrowing. The facts regarding the history and evolution of the troubled teen ‘toughlive’ industry are interesting and informative. If satan were to incarnate in a human body, I think he might look something like the creators and sustainers of WWASP.
My perspective as a reviewer is first, as a mother of a daughter who spent nine months in a residential treatment center in Utah in 2005 for treatment of profound depression and suicidality. Secondly, I am a practicing pediatrician and a former master's level social worker. I have personally read nearly every reference which Ms. Szalavitz has used for documentation. I found this book to be written in a very even-handed fashion, especially considering the incendiary nature of the topic and the damning evidence of continuing abuses which continue to be revealed on nearly a daily basis in small, regional publications throughout the country.
It was critically important that Ms. Szalavitz' present the natural evolution of the "teen help" programs as descended from The Straights, because although some of the programs she has thoughtfully dissected are no longer in existence, many of their basic tenets and operational principles have been passed down to new generations of programs. Beliefs such as that all kids are "manipulators" and are therefore not to be trusted, and that kids who arrive in treatment programs must have done something bad and therefore do not deserve respect, are rampant, including in the "good" program which my daughter attended. I fully believe that my daughter and our family were helped by the program she attended, but that doesn't diminish my belief that there is potential for great harm to occur to individual children within individual programs because of a lack of regulatory oversight of these programs. I was particularly impressed with the way Ms. Szalavitz applied her knowledge of both individual psychological forces and sociocultural factors to help the reader understand how even the most egregious programs can flourish and how both parents and kids who have been involved with them can defend them.
As reported by Ms. Szalavitz, the teen behavioral health industry is a billion-dollar a year enterprise, in spite of the fact that a 1999 report by the Surgeon General stated that "there is only weak evidence for their (residential treatment centers) effectiveness" and that "it is premature to endorse (their) effectiveness." Further, in 2004, the NIH concluded that scare tactics used in boot camp type programs "don't work and there is some evidence that they may make the problem worse rather than simply not working." Ms. Szalavitz importantly notes that in spite of a mountain of evidence of demeaning and damaging abuses which have occurred to children in a variety of residential programs in the U.S., both state and federal governments have largely refused to provide oversight to ensure our children's safety. Proposed federal legislation intended to do just that has languished because of a lack of bipartisan support.
Above all, I found Ms. Szalavitz' book to be a heartfelt plea to gather more evidence and do more research to find out what interventions will be truly efficacious for our troubled teens while also embracing the primary tenet of medicine to "Do No Harm." Our society would do well to follow her suggestions in this regard.